PubMed Health⌕ Search

Biomedical subjects

Mark Ballow

Publications and source records attributed to Mark Ballow.

At least 19 recordsLinked to original sources
PubMed2006

Reliability and validity of the Asthma Trigger Inventory applied to a pediatric population.

OBJECTIVE: To test the reliability and validity of the Asthma Trigger Inventory (ATI) applied to a pediatric population. METHOD: Children with asthma (N = 272, 56% male, age 7-17) and their primary caregivers answered together an asthma trigger inventory, ATI (Ritz, Steptoe, Bobb, Harris, & Edwards, 2006) developed for adults. Cronbach's alpha, principal component analysis (PCA), hierarchical regression, and correlations of the ATI subscales with skin prick tests, psychological questionnaires, and disease severity were used to assess the psychometric properties of the ATI. RESULTS: The ATI subscales demonstrated excellent reliability regardless of gender, race, socioeconomic status (SES), or age. PCA confirmed and replicated the theoretical structure of the ATI. Hierarchical multiple regressions illuminated the association of ATI subscales with demographics and asthma history. Evidence in support of construct validity was found in associations between ratings of triggering and disease severity and asthma-related quality of life (PAQLQ). Criterion validity for allergy triggering was partially supported by correlations between ATI animal allergens subscale and the cat dander skin prick test, and construct validity for emotional triggering by associations between the emotional trigger subscale score and the anxiety (STAIC) and depression (CDI, CDI-P, CDRS-R, and CBCL-I) scores. CONCLUSION: The ATI holds promise as a reliable, valid, and useful clinical and research tool to assess the type and degree of asthma triggering in a pediatric population (age 7-17) of varied gender, race, and SES.

Asthma↗
PubMed2006

Family emotional climate, depression, emotional triggering of asthma, and disease severity in pediatric asthma: examination of pathways of effect.

OBJECTIVES: (a) To assess emotional triggering of pediatric asthma and ascertain its contribution to disease morbidity and functional status; (b) to test whether negative family emotional climate (NFEQ) is associated with depressive and/or anxious symptoms and emotional triggering of asthma attacks in the child. METHOD: Children with asthma (N = 272, 56% male, age 7-17) and their primary caregivers answered together an Asthma Trigger Inventory (Ritz, Steptoe, Bobb, Harris, & Edwards, 2006). Children reported on anxious (STAIC) and depressive (CDI) symptoms and on asthma-related quality of life (PAQLQ). Parent(s) reported on their child's internalizing (CBCL-I) and depressive symptoms (CDI-P). A clinician also rated the child's depression using the structured CDRS-R. Asthma diagnosis was confirmed and disease severity rated according to NHLBI guidelines by an asthma clinician. RESULTS: Path analyses indicated that NFEQ was associated with depressive symptoms, which in turn were associated both directly and indirectly (by way of emotional triggering) with disease severity. Comparison of nested models indicated the possibility of differential roles and pathways for anxious versus depressive symptoms. CONCLUSION: Findings elucidate possible pathways of effect by which family emotional climate and child depressive symptoms may influence pediatric asthma disease severity by way of potentiating emotional triggering of asthma.

Adolescent↗
PubMed2006

Biologic immune modifiers: Trials and tribulations--are we there yet?

Biologic agents as therapeutic modalities have emerged as an important new drug treatment. This article focuses on specific groups of immune response modulators of mAbs and recombinant proteins, and their use or their potential use in asthma as an example of an inflammatory allergic process. Although some of these new biologic agents are currently used only in animal models of allergic disease or in other inflammatory or autoimmune diseases, this field is advancing so rapidly that in a few years, these new treatment modalities could be applied to allergic diseases. This article provides a brief rationale for the use of these new biologic agents in asthma. Although optimism is very high for this new class of drugs, caution is needed in extrapolating in vitro data or studies from animal models; adverse events will happen. Nevertheless, as we learn how to modify and alter the inflammatory and immune processes with these new biologic agents, clinicians will enter a new era of treatment options available for their patients with allergic disorders.

Animals↗
PubMed2006

Use of intravenous immunoglobulin in human disease: a review of evidence by members of the Primary Immunodeficiency Committee of the American Academy of Allergy, Asthma and Immunology.

Human immunoglobulin prepared for intravenous administration (IGIV) has a number of important uses in the treatment of disease. Some of these are in diseases for which acceptable treatment alternatives do not exist. In this review we have evaluated the evidence underlying a wide variety of IGIV uses and make specific recommendations on the basis of these data. Given the potential risks and inherent scarcity of IGIV, careful consideration of the indications for and administration of IGIV is warranted.

Asthma↗
PubMed2006

Association of depressive symptoms and disease activity in children with asthma: methodological and clinical implications.

OBJECTIVE: This study was designed to assess the prevalence of depressive symptoms in children with asthma and the association between depression and asthma activity. METHOD: Children ages 7 to 17 (n = 129) were recruited from a hospital emergency department after presenting for asthma symptoms. The majority of subjects were from disadvantaged, inner city families. Subjects' asthma disease activity was assessed using the revised National Heart, Lung, and Blood Institute guidelines, and subjects' emotional status was assessed by a combination of self-, parent-, and clinician-reported measures. Parental emotional status was assessed by self-report. RESULTS: Depressive symptoms within the clinical range were reported in 26% of subjects and 43% of mothers, although symptom severity varied across scales. Self-reported depressive symptoms were more strongly correlated with asthma activity (r = 0.25) than clinician-reported (r = 0.14) or parent-reported symptoms (r = 0.12/0.18). Depressive symptoms in parents were correlated with child's depression scores but not with their asthma activity. CONCLUSIONS: Depressive symptoms were common and associated with asthma activity in this inner city population of asthmatic children. Self-reported depressive symptoms were more strongly associated with child's asthma activity than either parental depression or parental/clinician ratings of the child's depression.

Adolescent↗
PubMed2006

Family relational factors in pediatric depression and asthma: pathways of effect.

OBJECTIVE: This study tested a multilevel biobehavioral family model proposing that negative family emotional climate contributes to child depressive symptoms, which in turn contribute to asthma disease severity. Parent-child relational insecurity is proposed as a mediator. METHOD: Children with asthma (N = 112; ages 7-18; 55% male) reported relational security, anxiety, and depressive symptoms. Parent(s) reported demographics, asthma history and symptoms, and family emotional expression. Asthma diagnosis was confirmed by medical history provided by parent and child together, clinical evaluation, pulmonary function tests, and methacholine challenge, with disease severity categorized by National Heart, Lung, and Blood Institute guidelines. Medication adherence was measured prospectively. RESULTS: Path analysis indicated a good fit of data to the hypothesized model (chi2 = 0.072, p =.97, normal fit index = 0.998, root mean square error of approximation = 0.000). Negative family emotional climate predicted child depressive symptoms (beta =.21, p < .04), which predicted asthma disease severity (beta =.35, p < .001), with relational insecurity a partial mediator (beta = -.23, p < .05, beta =.46, p < .001, respectively). Depression was associated with disease severity even after controlling for adherence (r p = 0.38, p < .05). CONCLUSION: Findings are consistent with the proposed family model, suggesting the clinical importance of assessing and intervening in these specific family relational processes when treating children with depression and asthma.

Adolescent↗
PubMed2006

Initiation of maintenance antiinflammatory medication in asthmatic children in a pediatric emergency department.

BACKGROUND: Despite National Asthma Education and Prevention Program guidelines recommending the use of daily controller medication in patients with persistent asthma, less than half of children requiring emergency department treatment for asthma exacerbations are receiving antiinflammatory therapy. OBJECTIVE: The purpose of this study was to evaluate a pediatric emergency department-based intervention designed to affect the prescribing practices of primary care physicians to better comply with national asthma guidelines. The intervention involved initiating maintenance antiinflammatory therapy in children with an asthma exacerbation who met guidelines for persistent disease but were not on antiinflammatory medications. METHODS: Guardians of children 2 to 18 years of age presenting to the pediatric emergency department with an asthma exacerbation were asked to complete an asthma survey. Patients were classified into severity categories. Those with persistent disease not on antiinflammatory medications were given a 2-week supply of medication and were instructed to follow-up with their primary care physicians to obtain a prescription for the antiinflammatory medication. Patient adherence information was obtained through telephone calls, pharmacy claims data, and physician office records. RESULTS: Forty-seven of 142 patients met criteria and were enrolled in the intervention. Seven patients were lost to follow-up. Of the remaining 40 patients, 28 followed-up with their primary care physician. Of these patients, 75% were continued on an antiinflammatory medication. Primary care physicians were significantly more likely to continue an antiinflammatory prescription in patients with severe persistent asthma (88.9% vs 68.4% of mild- or moderate-persistent asthmatics). Of the 28 patients who followed-up with their primary care physician, 13 had a prescription written, dispensed, and reported using the medication at the time of follow-up. CONCLUSIONS: Pediatric emergency department physicians can successfully partner with primary care physicians to implement national guidelines for children requiring maintenance antiinflammatory asthma therapy. Patient nonadherence continues to be a significant barrier for asthma management.

Adolescent↗
PubMed2005

Clinical and investigational considerations for the use of IGIV therapy.

PURPOSE: Clinical uses of immunoglobulin intravenous (IGIV) therapy for a number of autoimmune and inflammatory diseases are discussed, as well as the probable mechanisms by which IGIV exerts its immunoregulatory and antiinflammatory actions. Case studies are also presented to examine practical considerations in the selection of IGIV products for patients at risk for adverse events. SUMMARY: At present, the Food and Drug Administration has approved IGIV for use in six conditions, including replacement therapy for patients with antibody-deficiency disease, adjunct therapy in patients with poor antibody-producing capabilities, prophylaxis against certain types of infections, and several autoimmune disorders, including idiopathic thrombocytopenic purpura and Kawasaki disease. Numerous mechanisms have been proposed to explain the beneficial effects of IGIV, including the interaction of infused IgG with fragment crystallizable (Fc) receptors and complement proteins, the modulation of synthesis and release of cytokines and cytokine antagonists, and neutralization of circulating autoantibodies.IGIV products differ significantly in methods of production, virus elimination, formulation, and composition. These differences can potentially have an impact on safety, tolerability, and efficacy. The major features affecting tolerability include volume load, sugar and salt content, and osmolality. Case studies highlight how these product characteristics could affect patient outcomes. CONCLUSION: While numerous mechanisms have been proposed to explain the beneficial effects of IGIV, the specific mechanisms remain elusive. Patient outcomes can be affected by IGIV product characteristics. The choice of an IGIV product should be matched to the patient's risk-factor profile.

Adult↗
PubMed2004

Lymphocyte subpopulations and cytokines in nasal polyps: is there a local immune system in the nasal polyp?

PURPOSE: The pathogenesis of chronic hyperplastic rhinosinusitis with massive nasal polyposis is still not entirely known. The present study evaluates the lymphocyte subpopulations and their production of cytokines using a technique for detection of intracytoplasmic cytokines by flow cytometry. This information may allow us to determine whether the source of these lymphocytes is from peripheral blood, the common mucosal immune system, or both. METHODS: Detection of intracytoplasmic cytokines by flow cytometry was performed using a fluoresceinated monoclonal antibody directed against CD4+ and CD8+ lymphocytes and a rhodamine-labeled intracytoplasmic monoclonal antibody directed against four cytokines. In this way, the percentage of lymphocytes synthesizing TH1 and TH2 cytokines were identified in nasal polyp lymphocytes and the corresponding peripheral blood lymphocytes of 13 patients. RESULTS: Lymphocytes producing interferon-gamma and IL-2, as well as IL-4 and IL-5, were found in the nasal polyps, suggesting that the nasal polyp possesses both TH1 and TH2 cytokine expression. There are also significant differences between the percentage of lymphocytes producing these cytokines between nasal polyps and peripheral blood, suggesting that nasal polyp lymphocytes derive from at least another source than only peripheral blood lymphocytes. Statistical analysis of four groups of patients demonstrated that no statistically significant difference in the lymphocyte subpopulations in atopic versus non-atopic patients, nor aspirin-intolerant versus aspirin-tolerant patients. In general, CD8 cells always produce more interferon-gamma than IL-2 in both peripheral blood and nasal polyps. In contrast with this data, CD4 cells produce more IL-2 in the peripheral blood than in nasal polyps. CONCLUSIONS: Data support the concept that nasal polyp lymphocyte subpopulations may be derived from both the local mucosal immune system as well as from random migration of peripheral blood lymphocytes secondary to adhesion molecules and chemokines, which are known to be present in nasal polyps.

Adenoids↗
PubMed2004

Developing resources to teach and assess the core competencies: a collaborative approach.

Graduate medical education programs face new challenges as they seek to comply with the mandate from the Accreditation Council on Graduate Medical Education to demonstrate that they are teaching and assessing residents on the six core competencies. The authors describe a project designed as a collaborative venture between the American Academy of Allergy, Asthma, and Immunology (AAAAI) and the Center for Educational Outcomes at Dartmouth College (CEdO) to provide residency programs in allergy/immunology with resources for teaching and assessing the core competencies. The goal was to create a set of learning and assessment resources that maximized the content knowledge expertise provided by the AAAAI and the learning expertise provided by CEdO. A highly interactive, iterative process was used to create a set of Web-based modules. Bilateral communication, buy-in, and active involvement in the process were seen as crucial to the development of resources and their successful implementation. Approximately 18 months after the modules were made available to training program directors, 80% of the directors surveyed were aware of and had accessed the modules. The joint creation process used in this project, designed to be generally applicable across specialties, reveals how the burden of meeting new requirements can be decreased when experts in content knowledge and experts in learning collaborate.

Accreditation↗
PubMed2003

Comparison of the efficacy of IGIV-C, 10% (caprylate/chromatography) and IGIV-SD, 10% as replacement therapy in primary immune deficiency. A randomized double-blind trial.

A novel method of large-scale chromatography has been developed to improve recovery and purity of immunoglobulin G (IgG) from pooled plasma. The current study compares safety, toxicity and efficacy of two intravenous immunoglobulin products: a novel formulation, IGIV caprylate/chromatography (IGIV-C; Gamunex, 10%) and a licensed solvent/detergent-treated product, Gamimune N, 10% (IGIV-SD). The study, a randomized, double-blind, parallel group, therapeutic equivalence trial, was conducted at 25 treatment centers in Canada and the United States. Patients (n=172) having confirmed chronic primary immunodeficiency (PID), aged 1-75 years, and receiving IGIV therapy were enrolled. For 9 months, patients were treated with IGIV-C or IGIV-SD in accordance with the patient's individualized treatment regimen utilized before study entry. The primary endpoint was the proportion of patients with >or=1 validated acute sinopulmonary infection during the treatment period. Secondary endpoints included the proportion of patients with all infections, time to first infection, annual infection rates, lung function parameters, infusion-related safety and viral safety. The annual validated infection rate in the IGIV-C group was 0.18 compared to 0.43 in the IGIV-SD group (p=0.023). Nine patients receiving IGIV-C experienced validated infections, compared to 17 patients in IGIV-SD group (p=0.06). Acute sinusitis (validated plus clinically defined) was less frequent in the IGIV-C group (p=0.012). Presence of bronchiectasis did not affect efficacy. Adverse reactions were similar in frequency and severity in both groups. No evidence of viral transmission was observed. IGIV-C appears to be superior to IGIV-SD in preventing validated sinopulmonary infections, especially acute sinusitis, in patients with PID.

Adolescent↗
PubMed2003

Expression and regulation of nuclear retinoic acid receptors in human lymphoid cells.

Retinoids are known to play an important role in cellular growth and differentiation and more recently in the immune response. Our laboratory has previously shown that all-trans-retinoic acid (atRA) augments immunoglobulin synthesis of cord blood mononuclear cells by enhancing the synthesis of certain cytokines. Transcriptional regulatory elements, the retinoic acid nuclear receptors (RAR), could mediate the RA-induced regulation of genes, e.g., cytokines whose products are involved in the pathways of immunoglobulin synthesis. Although much is known about RAR in various animal species and tissues, little is known about the expression of RAR and its isotypes in human lymphoid cells. In this study, we examined the RAR isotypes (RAR-alpha, RAR-beta, RAR-gamma) and their respective isoforms in T- and B-lymphoid cells using a quantitative RT-PCR assay. RAR-alpha1 and -gamma1 were both constitutively expressed and did not change with the addition of atRA to human T- and B-cell lines or adenoidal T and B lymphocytes. In contrast, RAR-beta2 was not detected. The addition of atRA to cell culture produced a marked increase in the amounts of RAR-beta2 mRNA (2.2- to 41-fold). As with the RAR-beta2 isoform, the addition of atRA increased RAR-alpha2 mRNA levels (3.4- to 17-fold), but only in EBV-transformed B cells and adenoidal B lymphocytes. The RAR-beta1 and -beta3 isoforms were undetectable in lymphoid cells and not inducible with atRA. RAR-gamma2 was expressed at very low levels and was not inducible with atRA. Our results suggest that the expressions of the RAR-alpha2 and -beta2 isoforms in lymphoid cells are highly controlled by atRA. Differences in the regulation of RAR isoforms by atRA in human lymphoid cells may be an important factor in the modulation of cytokine production and the augmentation in Ig synthesis by atRA.

Animals↗
PubMed2003

26. Immunomodulation and immunotherapy: drugs, cytokines, cytokine receptors, and antibodies.

The preceding chapters in this primer have provided an overview of the immune response that serves as a background for understanding potential sites for immune modulation and immunotherapy. A number of soluble growth and activation factors are released from various cell populations involved in the immune response. They play vital roles in the initiation, propagation, and regulation of immunologic responses. Pharmacologic immunomodulators include suppressive and stimulatory agents. Immunosuppressive therapies include antimetabolites, cytotoxic drugs, radiation, adrenocortical glucocorticosteroids, immunophilins, and therapeutic antibodies. The field of clinical immunostimulation is emerging as an important therapeutic modality for a number of immunodeficiency diseases, chronic viral infections, and cancer. These compounds will be discussed in terms of general principles, molecular targets, major indications, and adverse effects.

Adjuvants, Immunologic↗
PubMed2003

Role of cytokines in nasal polyposis.

Chronic hyperplastic sinusitis and nasal polyposis (CHS/NP) is associated with significant morbidity. The response to medical treatment is often unsatisfactory, and surgery often provides only temporary relief. The genesis and pathophysiology of polyps are poorly understood. There has been increasing interest in the role of inflammatory mediators such as cytokines and chemokines in the pathogenesis of chronic sinusitis and nasal polyposis. Recent data from several investigators offer insights into the cellular content of polyps and their capacity to produce cytokines and orchestrate the inflammatory process.

Administration, Topical↗
PubMed2002

Primary immunodeficiency disorders: antibody deficiency.

As a group, antibody deficiencies represent the most common types of primary immune deficiencies in human subjects. Often symptoms do not appear until the latter part of the first year of life, as passively acquired IgG from the mother decreases to below protective levels. As with the T-cell immune deficiencies, the spectrum of antibody deficiencies is broad, ranging from the most severe type of antibody deficiency with totally absent B cells and serum Igs to patients who have a selective antibody deficiency with normal serum Ig. In addition to the increased susceptibility to infections, a number of other disease processes (eg, autoimmunity and malignancies) can be involved in the clinical presentation. Fortunately, the availability of intravenous immune serum globulin has made the management of these patients more complete. Recently, molecular immunology has led to identification of the gene or genes involved in many of these antibody deficiencies. As discussed in this review, this has led to a better elucidation of the B-cell development and differentiation pathways and a more complete understanding of the pathogenesis of many of these antibody deficiencies.

Agammaglobulinemia↗
PubMedDate not supplied

Intravenous immunoglobulins: clinical experience and viral safety.

OBJECTIVES: To discuss the current procedures and processes by which viral safety is ensured for intravenous immunoglobulins (IVIGs), to place in context the current increase in clinical indications for IVIGs, and to describe the safety issues that have led to product shortages. DATA SOURCES: Articles on viral safety retrieved from MEDLINE using the search terms gamma globulin, intravenous, adverse reaction, and infection and information from the manufacturers' literature and Food and Drug Administration package inserts. STUDY SELECTION AND DATA EXTRACTION: Studies that specifically addressed the areas of major concern or advancement in viral safety of IVIGs, including donor selection, plasma screening, and other quality control procedures to ensure safety of source plasma; detection of viruses that may have escaped antibody screening tests through the use of polymerase chain reaction-based assays, which are capable of detecting small amounts of viral genomic material (e.g., hepatitis C virus, hepatitis B virus, and human immunodeficiency virus [HIV]) in small plasma pools; and industrial-scale, validated viral inactivation methods, such as pasteurization and solvent/detergent treatment, that have been incorporated into the manufacturing processes of immunoglobulins to further minimize the risk of viral transmission. DATA SYNTHESIS: In addition to the treatment of primary immunodeficiency disorders, the clinical uses of IVIGs have expanded to include treatment of Kawasaki's syndrome, idiopathic thrombocytopenic purpura, infection following bone marrow transplantation, secondary immunologic disorders (e.g., pediatric HIV infection), hematologic disorders (e.g., chronic lymphocytic leukemia), and neurologic indications (e.g., Guillain-Barré syndrome). Although IVIG preparations are derived from human plasma, they have a long safety record and a low risk for transmitting viral infections. CONCLUSION: Viral validation studies demonstrated that the processes discussed herein differ in their capabilities to inactivate lipid-enveloped and nonlipid-enveloped viruses.

Drug Industry↗